Spring 2010 Issue

From the President
Gary R. Katz, MD, MBA, FACEP

I was at a recent meeting of medical leadership and heard several comments that can be best summed as “the golden age of medicine is over.” As I listened to the commentary, I couldn’t help but think that, despite the morose opinions, perhaps the leadership has it wrong. While yesterday’s golden age may have gone, a new golden age could be just beginning: an environment that assists physicians in using new technology; integrated health care models to reduce unnecessary testing; and new methods of bringing value and enabling better health to each of our patients.

Of course, these thoughts and comments are directly linked to one’s liking or disliking of the Patient Protection and Affordable Care Act of 2010. President Obama’s signing of the historic Health System Reform bill on March 23rd certainly is not the end of the issue for us. On the contrary – we are left with the task of trying to figure it out, carrying on the fight for a permanent fix for the SGR, and preparing for what is to come.

There are plusses and minuses to this bill and I share both your hopes and concerns. Does this bill help assure access or just that each person has insurance? Is this bill really fiscally responsible or does it attain this solely on the backs of physicians? Did we really miss the boat on tort reform? How does this era of bigger government impact the sanctity of the patient-physician relationship and our ability to deliver evidence- based leading edge medical care?

While national ACEP is the mechanism to best raise these questions and advise the fixes on the national level, your Ohio chapter is well poised to assist you as these changes impact us locally. We can do this through our strategic efforts to enhance the environment in which we practice and the education tools we use to keep us delivering the highest quality care.

In prior issues you have read my appeal for you to contact your State Senator to vote in favor of Senate Bill 86, Access to Emergency and Disaster Care. This legislation is set to help us tackle the on-call problems that limit the care we can effectively provide our patients in our home communities. It is still essential that you make this call. Review Dr. Marco’s summary and tips on making this contact below.

The evidence is clear. Reforming the tort system shifts the risk equation and encourages specialists to take call when previously they had only disincentive to do so. When other states have enacted similar legislation they saw health care access improve and on-call limitations decrease; all while achieving superior core-measure quality metrics. Senate Bill 86 is a no-cost way to safely enhance access.

Through this time of health system change, Ohio ACEP remains dedicated to being the industry leader in Emergency Medical continuing education. I am confident that our extensive education offerings will continue to provide expanded value to you. Early this year Ohio ACEP acquired the right to continue the publication and sale of Dr. Carol Rivers’ Preparing for the Written Board Exam in Emergency Medicine and Preparing for the Oral Board Exam in Emergency Medicine. This package is an added dimension to our highly successful Emergency Medicine Review (EMR) course based in Columbus, (August 23-27 and October 9-13, 2010) which has long been hailed as a national benchmark in EM education.

Next, we know that your medical education cannot rely solely on analog information (text books) and that your time does not always allow for travel to destination education. For this reason, we are developing new strategies for interactive educational media on your home smart devices. The first will be an app to provide Emergency Medicine review for your i-phone/i-pad compatible electronics. The release date is anticipated to be this summer. Through this and other interactive media we hope we will add value to your education effort.

We may be passing into a new age of medicine. Only time will tell if it’s truly “golden.” However, Ohio ACEP remains dedicated to vigilance and leadership on all fronts to build our practice environment and help us deliver world-class emergency health care right here in Ohio.

I hope such a strategy will be valuable to you.

Yours in Service,
Gary

Who’s Paying for This?
Notes from Jonathan Siff, MD, FACEP
Chair, Ohio ACEP Reimbursement Committee and David Chauvin, MD

With the passage of health care reform there is a lot of uncertainty about the future of our payment and reimbursement systems. For the near term I expect our processes to work under the current framework. However, change is always happening and as CMS is required to squeeze half a trillion dollars out of Medicare over the next 10 years we can expect new programs and changes. ACEP will work to keep you informed as these start to take shape.

There is a fantastic resource developed jointly by the National ACEP Reimbursement and Coding and Nomenclature Committees available to ACEP members on the ACEP website. This is a collection of frequently asked questions (FAQ’s) about a variety of billing and coding issues. This collection may be useful to you or your billing staff. A full list of current topics with their most recent revision date is available. The list includes but is not limited to:

Documentation Guidelines FAQ 01/10
Mid-Level Provider FAQ 01/10
Ultrasound FAQs 01/10
X-Ray - EKG FAQ 01/09

Finally, in an effort to protect emergency physicians from unfair payment practices by certain payors ACEP has been participating in national lawsuits against insurers. One current initiative includes building a case against Blue Cross Blue Shield and Anthem for inappropriate denials of EKG interpretations when billed with an ED Evaluation and Management visit. It would be very helpful if you or your billing staff have examples of cases where an EKG was billed with an ED visit using modifier -25 (separate service) and the EKG was denied as being bundled into the ED visit. We are also interested in examples of the following billing practices by payors that unfairly deny emergency providers fair payment:

Bundling 12 Lead EKG into Critical Care
Bundling CPR into an E/M level
Non-recognition of modifiers -25 and -54 for fracture or dislocation care
Bundling E/M services into the Central Line, CPT 36556.

You can contact Amy Wynn with national ACEP for more information on how to submit these cases.

Ohio ACEP wants to hear from you. What challenges are you facing from insurers, payors, auditors or other entities that are adversely impacting your ability to get paid for your services? Please tell us by contacting Laura Tiberi or Jonathan Siff, MD Chairman of the Ohio ACEP Reimbursement Committee.

Update from Dr. Catherine Marco, Chair, Government Affairs Committee

A bill is being considered by the Ohio Senate that would increase liability protection for emergency physicians and on-call specialists who provide EMTALA mandated care and disaster care. Senate Bill 86 proposes raising the medical malpractice standard to require proof of “reckless disregard” for all physicians providing EMTALA related care, and all physicians and nurses in a disaster. The bill has had six committee hearings. Unfortunately, the bill was not voted out of committee before the Senate took a break. What can Ohio ACEP members do? CONTACT YOUR STATE SENATOR and tell them:

Senate Bill 86- Access to Emergency and Disaster Care will:

• Encourage participation in emergency medical care by removing disincentives from taking ER call
• Improve access and quality of emergency care for patients in the State of Ohio

Essential on-call services to emergency patients are often in critically short supply, due largely to:

• increased liability exposure
• higher liability premiums
• reduced collections rates from ER patients

State liability laws should act to encourage these specialists to provide vital on-call services to emergency patients, not inhibit them.
Ask your state senator to support Senate Bill 86.

Attend ACEP’s Leadership and Advocacy Conference
May 16-19, 2010 - Washington, DC

At the Leadership & Advocacy Conference, you will have the opportunity to learn advocacy skills, be exposed to the latest issues facing emergency medicine and receive updates directly from members of Congress. At the end of the conference you will have the chance to walk across the mall and take an active part in forming healthcare policy. Bring your excitement to learn and your desire to advocate for the rights of patients, physicians and emergency medicine. ACEP's National Lobby Day is May 18, 2010.

Call for Ohio ACEP Board and Councilor Nominations

Bring Your Leadership to Chapter Service!
All active members of Ohio ACEP interested in serving on the Board of Directors or representing the Chapter as a Councilor are encouraged to submit their names to the 2010 Leadership Development Committee for consideration as the Committee develops the slate of candidates. New Board members and Councilors will be selected by the membership present at the Annual Member Meeting at the Hilton at Easton, June 9, 2010, in Columbus, Ohio.

At the Annual Meeting, Board members shall be elected by ballot by majority vote of the Chapter membership present. Board members shall serve for three years or until their successors are elected with approximately one-third of the members being elected every year. Board members have no term limits and may run for consecutive terms. Their terms of office shall begin at the close of the Annual Meeting at which they are elected.

Three Board members will be elected by the membership for three year terms at the Annual Meeting. Current Board members with expiring terms are eligible for re-nomination and re-election. The terms expiring are: James M. Horn, MD (Mason, OH) and Thomas A. Tallman, DO, FACEP (Cleveland, OH). There is also a seat to be filled due to Board member resignation.
In addition, Ohio's Emergency Medicine residents will elect a resident representative to the Board of Directors for a one year term.

There are also six available Chapter Council seats. Current Councilors are eligible for re-election to a two-year term if they choose to run. These seats are currently held by: Robert Broida, MD, FACEP (Akron); C.C. Halloran, MD, FACEP (Shaker Heights); Mary Hancock, MD, FACEP (Elyria); Thomas W. Lukens, MD, FACEP (Lakewood); Michael D. Smith, MD, FACEP (Brecksville); and Thomas A. Tallman, DO, FACEP (Shaker Heights).

Up to twelve Alternate Councilors are also needed. If a Councilor is not present at a College Council meeting, an Alternate Councilor will be seated in place of the absent Councilor.

At the Annual Meeting of the Chapter, the members of the Chapter present shall, by majority vote, elect Councilors to fill those positions which will not automatically be filled by the incoming President or by Councilors serving unexpired terms. The total number of Councilors shall be determined by the number of members on the membership roll on December 31 of each preceding year. Ohio Chapter ACEP has been allotted twelve (12) Councilors for the September 2010 Council meeting in Las Vegas.

Interested candidates should forward their name, a short biographical sketch and a declaration of intent and ability to serve, along with a CV to Laura Tiberi, Executive Director at the Chapter office NO LATER THAN May 15, 2010. 

Save The Date! Ohio ACEP Residents’ Assembly and All Member Annual Meeting

This year the Ohio ACEP Residents’ Assembly and All Member Annual Meeting will take place on June 9, 2010 at the Columbus Hilton at Easton in Columbus, Ohio. The Residents’ Assembly combines the “Life After Residency” program geared towards practice options, interview skills, reading and negotiating a contract and information on medical malpractice and professional liability insurance with the annual meeting, a healthcare roundtable and a leadership presentation by Dr. Thom Mayer. Geared primarily towards later second year or new third and fourth year EM residents, the day also features the opportunity to visit with EM practice groups with positions to fill. Whether ready to look for a position or reviewing your options, come ready to engage! Click here for more information.

All Ohio ACEP Members are invited to attend the Annual All Member Meeting and Awards Luncheon at the Hilton Columbus at Easton on June 9 from 12 - 4:30 p.m. The Annual Meeting provides members an opportunity to learn more about priority issues of Ohio ACEP and actively participate in the organization. This opportunity to network with Ohio and National EM colleagues, discuss pressing issues facing the practice of emergency medicine for physicians and patients and elect your representatives to the Ohio ACEP Board of Directors should not be missed! Join your colleagues for Board elections, Ohio ACEP EM Awards and special guests ACEP President-Elect Sandra Schneider, MD, FACEP and Dr. Thom Mayer speaking on "Leadership: Healthcare's Most Important Frontier."

Ohio Medicaid Initiative: IMPROVE - “Implement Medicaid Programs for the Reduction of Avoidable Visits to the Emergency Department”

The Ohio Department of Job and Family Services (ODJFS) in collaboration with key stakeholders inclusive of hospitals, community providers, managed care plans and Medicaid consumers is initiating a statewide effort to reduce avoidable emergency department (ED) visits. This initiative is the “Implement Medicaid Programs for the Reduction of Avoidable Visits to the Emergency Department” (IMPROVE). Despite current efforts to reduce avoidable ED visits, more than half of the ED services utilized by Medicaid members were non-emergent and could have been treated safely and effectively in a primary care setting. ODJFS and key stakeholders recognize the need to address avoidable ED visits through a multifaceted approach that maximizes health care resources, encourages information sharing and promotes community-specific solutions as essential elements in re-directing patients seeking avoidable care in the ED.

A one day conference on April 28, 2010 will initiate the statewide collaboration effort with key Ohio stakeholders. Presentations will include ED utilization issues and initiatives from a national and Ohio perspective. Attending stakeholders will have opportunities to meet with five community-specific IMPROVE project leaders to provide input and dialogue to the development of these high impact and high volume ED community solutions.
If you would like to be involved as a representative of Ohio’s emergency physicians in regional work groups, please let Ohio ACEP Executive Director, Laura Tiberi, know of your interest!

Governor Creates Task Force to Coordinate Fight against Rx 'Pill Mills'

Gov. Ted Strickland signed an executive order on April 2, 2010 creating an inter-agency task force to bring together local, state and federal efforts in the fight against prescription drug abuse, which in recent years has surpassed car accidents as the leading cause of accidental death.
"Pain medication, when abused, ceases to treat pain and instead causes pain," he said. "Too many lives have been lost; too many people have been lost, chasing these pills."

George Maier, second-in-command at the Department of Public Safety, will be the task force chairman, while Dr. Alvin Jackson, director of the Department of Health, will be vice chairman. Members include lawmakers from the four legislative caucuses; a sheriff, prosecutor, coroner, county or city health director and a police chief; and representatives of Attorney General Richard Cordray; the State Medical Board and State Pharmacy Board; associations of health care providers and hospitals; the Ohio Poison Control Collaborate; the federal departments of justice and health and human services; and U.S. Sens. Sherrod Brown and George Voinovich.
The task force will be required to produce a report within six weeks on the scope of the prescription drug abuse problem and possible methods of fighting it through law enforcement, public health and legislative means.

ODH Director Dr. Alvin Jackson said the state needs to improve education of patients about the dangers of drug diversion - medicines prescribed to one person and given to or stolen by someone else - as well as the education of doctors regarding the risks of opiate pain relievers, particularly regarding situations where a patient becomes addicted to a drug that they were originally prescribed for a legitimate medical need.

One concept of particular interest and concern to Ohio’s EM physicians may be the focus on increasing efforts by pharmacists and doctors to check the Ohio Automated Rx Reporting System (OARRS). Medical professionals may need to voluntarily increase their use of OARRS, or face a legislative mandate to do so. The Ohio State Medical Association and Ohio ACEP support a comprehensive solution to prescription drug abuse and support the usage of OARRS as a tool for physicians, but neither organization supports mandatory usage.

ACEP Members in the News

ER doc calls primary care 'critical'
March 22: NBC's Robert Bazell discusses healthcare reform with Dr. Mark Mosely, an emergency physician at Ohio State Medical Center. 

ABMS Announces John McCabe, MD, FACEP, as Chair of its Board of Directors
The American Board of Medical Specialties (ABMS), the organization that oversees the certifications of physician specialties in the United States, announced at its Annual Assembly Meeting the appointment of John McCabe, MD, FACEP, as the 33rd chair of its Board of Directors, and the appointment of six new members to the Board. Congratulations Dr. McCabe!

AMA Foundation Recognizes former Ohio EM Resident, Dr. Nathaniel Schlicher
The AMA Foundation held its annual Excellence in Medicine Awards dinner on Monday, March 1, 2010, at the Grand Hyatt Hotel in Washington, D.C., during the AMA National Advocacy Conference. Former Ohio EM Resident (now practicing in the state of Washington), Nathaniel Schlicher, MD, JD, was one of the Early Career Physician Leadership Award recipients. Also a member of the EMRA Board of Directors and Legislative Advisor, Dr. Schlicher joined ACEP President, Dr. Angela Gardner, and President-Elect, Dr. Sandra Schneider at The White House before leaving D.C.

Ohio ACEP Members in the News
Ohio ACEP member Dr. Michael Nauss as featured on CNN commenting about health care reform.

Clinical News

U.S. H1N1 Vaccination Patterns Show Marked State Variation
Uptake of the influenza 2009 H1N1 vaccine by the American public showed a striking state-by-state variation, ranging from a high of 39% in Rhode Island to a low of 13% in Mississippi, the U.S. Centers for Disease Control and Prevention reported April 1.
Read the entire article

MRI Helpful in the Diagnosis of Spontaneous Intracerebral Hemorrhage
MR imaging and angiography can be a valuable adjunct for the diagnosis of spontaneous intracerebral hemorrhage, with a diagnostic yield of 42% in a prospective study of 160 patients. “Early routine MRI/MRA has substantial additive clinical benefit in patients who present with spontaneous [intracerebral hemorrhage] and/or [intraventricular hemorrhage], and it does affect management in a substantial subset of patients,” Dr. Christine Wijman said at the International Stroke Conference.
Read the entire article

New CME Feature Now Available in Every Newsletter

Originally printed in ACEP News, the “Focus On” series of articles brings the latest literature and best practices to help the busy emergency physician provide the best care possible.

This issue’s topic, Acute Ischemic Stroke, will help the physician identify the management steps in treating patients suspected of having AIS, understand the complex issues that determine appropriate candidates to receive thrombolysis, and understand the risks of using rTPA.

Read the article online and then take the CME quiz.

ACEP LLSA Resource Center Updated to Include 2011 Articles

The ACEP LLSA Resource Center is being updated today with new tools to help you prepare for your annual LLSA tests and maintain your ABEM certification. New today are the 11 articles on the 2011 Lifelong Learning and Self-Assessment Reading List, summaries of the articles on the 2010 list, and handouts from lectures on the 2009 list.

The ACEP LLSA Resource Center is one of the most valuable benefits of your ACEP membership. If you’ve never used it, take a few minutes to do so right now. You’ll find the list of all current readings (the 2008 through 2011 lists), information on the CCME-ACEP program EM:Prep, information on LLSA prep programs hosted by chapters, and links to LLSA-specific pages on the ABEM Web site. Then for ACEP members only is the really good stuff – the articles themselves – all 61 of them, which you won’t find anywhere else all in one place for no extra charge. The members-only area also contains article summaries published in Critical Decisions in Emergency Medicine and the handouts from the LLSA lectures at the 2009 Scientific Assembly.

How can you get it all? Go to the LLSA Resource Center. Click on the links for the information you want. If you want something in the “Resources Available to ACEP Members Only,” you’ll need to log on using your ACEP user name and password. If you’ve never done that before, just follow the instructions on the sign-in page. If you need more help, call ACEP Member Services, 800-798-1822, ext. 5.

And if you have comments, questions, or suggestions for improvement, e-mail.

ABOUT THE EMERGENCY MEDICINE FOUNDATION

The Emergency Medicine Foundation (EMF) is the oldest organization with the sole purpose of supporting research and education in the specialty, founded in 1972. EMF continues to fund priorities of the American College of Emergency Physicians. The purpose of the foundation is to serve as a catalyst to advance education and research in emergency medicine. To date, EMF has awarded nearly $10 million in research awards to advance emergency medicine science and to develop emergency medicine research. For more information, please visit www.emfoundation.org.

Going to the 2010 ACEP Leadership and Advocacy Conference?

The Emergency Medicine Foundation looks forward to honoring our major donors and Wiegenstein Legacy Society members at this fun event. (By invitation only)

Leadership Appreciation Reception
Sunday, May 16 / 7:30 pm - 10:00 pm
Petit Plats Restaurant
2653 Connecticut Ave, NW
Washington, DC 20008

If you are interested in becoming a major donor, go to: www.emfoundation.org to make a tax-deductible charitable gift on-line. Proudly underwritten by VidaCare.

Welcome New Members

Jennifer Brown 
Kanwal B. Chickering, DO 
Rob Grover 
Jesse Gurm 
Laura Landis 
James Luz
Jacob McKeegan 
Warren K. Reiss, DO 
Rory T. Strugalski 
David Zaghlool